The Privilege of a Housed Drug User

by Amanda Smiles/PNN

For some reason, it is nicer than I expected. The modest conference room facing the entrance of the Women's Building is lit a warm marigold yellow and crowded with mutters of buzzwords such as "needle exchange," "harm reduction," and "HIV prevention."

I seat myself toward the front and whisk my eyes through the eclectic groups of scruffy activists, high heeled social workers, suit and tie public health workers, purple haired outreach workers, and everything in between community members, noting the organizations on their name tags. Harm Reduction Coalition, Stop the Drug War.org, San Francisco AIDS Foundation, Saint James Infirmary, and Homeless Youth Alliance, just to name a few. Yes, I think to myself, as a feeling of comfort snakes through my body, these are my people, here to discuss the next step in a human rights based public health policy: Safer Injection Facilities.

Safer Injection Facilities (or SIFs) are nothing new. The first facility was started in 1986 in Switzerland, which now is home to 12 additional facilities. There is a total of 65 SIFs around the world, largely concentrated in European countries such as Germany, the Netherlands, Spain, and soon Italy and Portugal. Australia hosts one SIF and North America has one, which opened in Vancouver in 2003.

Safer Injection Facilities are just that, a clean and sterile place where injection drug users can come to shoot their drugs without worrying about being hassled by the cops or being in the public eye. It gives people a place where they can take their time to shoot, doing it slowly and properly, reducing the risks of abscesses and HIV and Hepatitis C transmission.

Clean needles and sterile supplies are dispensed to clients; registered nurses are there to supervise all injections. Most importantly, however, if someone overdoses nurses respond immediately by performing rescue breathing, administering Narcan (the stuff that bring you back), or calling the paramedics. Although there have been many overdoses in SIFs to date no one has ever died from an overdose in an SIF.

As the noise settles and the symposium gets under way, my mind drifts back to the day I went to get my HIV test results. I used to be an injection drug user. Late one night, in desperation to get high I shared a needle with someone. I’m still not positive who it was. Also, we used to all share the same bloody tie and dirty spoon. Anyone who has gotten an HIV test after being at a real risk for contraction knows the agony of waiting for results. If not knowing if the consequence of one mistake can be more than a slap on the wrist. Thankfully, I am negative.

I think about my privilege of being a housed drug user. How that privilege gave me access to water from a tap opposed to water from toilets or puddles. That privilege guaranteed that the skin around the veins I shot into was clean, that when I shot I had enough light to see and hit my veins. That I was inside, out of the cold and rain, in private, where I didn’t have to rush. I could cook and filter my drugs properly, find my spot, and if I missed, I had enough time to try again. And still I put myself at risk. How would I of fared on the streets, without that privilege. Would my results of been the same?

Thomas Kerr, of the University of British Columbia, is the first to speak. For the past three years Kerr and a group of researchers have been evaluating Vancouver's SIF, called Insite, from a non-biased and scientific point of view. The results of the evaluation are astounding.

The most frequent clients of the facility are homeless, public injectors, daily heroine users who are at the highest risk for HIV and overdose. Insite sees a total of 1600 injectors a month, between 700 and 1000 repeat and unique injectors a day. Since Insite has opened 70 percent of clients have reported being less likely to share syringes. Public drug use and discarded syringes and injection related litter has reduced with increase use of the facility. After the site opened Kerr and his team found an increase in detox use among Insite clients and higher rates of entry into methadone and other drug treatment facilities. Nurses have reported a decrease in the number of abscesses in the emergency room and, of course, no one who has overdosed at Insite has died.

Captain Niels Tangherlini, from the San Francisco Fire Department Outreach Team, speaks next. He shows us a map of San Francisco pinpointing where all the overdose calls have originated in last year. Almost all the dots are concentrated in the Tenderloin and Mission Districts, making it impossible to focus on any other area of the map. The room inflates with gasps of shock when Captain Tangherlini explains that last year EMS received 76,000 calls, over 12,000 of which were from overdoses. Alex Kral’s, from the Urban Health Study, statistics are just as shocking. Among heroine users surveyed, 48 percent have over overdosed. 33 percent have overdosed two or more times. 13 percent have overdosed in the last year. These statistics are only from overdose survivors.

Again my mind floats back to another time in my life, when my ex- boyfriend overdosed. We were still living together. I was asleep after begging him to watch his use. I'm told he stopped breathing right after he hit himself. Luckily the girl he was with hadn't shot up yet and was able to react quickly enough to call the paramedics. They came to our house, performed rescue breathing, and gave him a shot of Narcan. I woke up 5 minutes after the ambulance pulled away. It was the second time he ODed.

I went to the hospital to get him. The overdose was so bad that he was at risk of going back into a coma. He would have died if the paramedics hadn't come. If he had been on the street, alone in an ally or even with someone without a phone, he surely would have died. That’s the thing with dope, if you use long enough, everyone ODs. It’s only a matter of who your with that determines if you live or not.

Sarah Evans, the Program Coordinator of Insite, is the last I see speak. She looks like the type of woman you would be comfortable telling anything. Petite with a choppy bob and small tender eyes, she speaks in a voice that is self assured yet sympathetic. Mostly she speaks about the side of Insite that deals in treatment and counseling.

Along with using the space for safe injection and the "chill out room," Insite clients have the option of talking to peer counselors, who are former and active drug users, or clinical psychologists. Insite’s second floor is a detox center and the third floor is for those in recovery. Insite decided to start it’s own detox and recovery center so people could not only get into treatment more quickly and efficiently but also so they could get treatment services from people they knew in an environment they feel comfortable in.

As Evans continues she shows pictures of clients in treatment and tells their story, always optimistic, always caring beyond the boundaries of a job. This is the side of Insite I am most impressed with, the side that infuses humanity and compassion into public health. As I think back not only to my story, but to the story of all the injection drug users I know and talk to, I realize that what San Francisco needs most is not only a place where people can practice their drug use safely, but also a place where people can come fully as themselves, without secrets or stigma, and can finally be seen as humans, instead of pieces of trash littering the streets.